Caregivers in long-term care facilities should screen residents using a suicide risk assessment tool in order to undertake appropriate interventions, according to experts in geriatric psychology and psychiatry.

Long-term care providers have had to grapple with the issue since the introduction of the MDS 3.0, which requires residents to answer questions about suicidal thoughts. A team from the University of Rochester, Mississippi State University and West Virginia University devised an action plan to help caregivers approach and respond to these potentially awkward conversations.

Customary methods for managing suicidal residents, such as observations every 15 minutes and psychiatric hospitalization, often do not work well, the researchers stated. These practices can burden caregivers and run up steep costs, which could be avoided in many cases if residents were categorized more effectively based their risk level for suicide.

The researchers endorse assessments such as the P4 screener, which consists of four questions that can be asked after a resident expresses thoughts of suicide. Clinicians can use the responses to assign a minimal, low- or high-risk score to the resident.

Based on the resident's risk level, the caregiver can then intervene using actions outlined in the researchers' decision tree. Potential actions include referring the resident to a mental health provider or placing the resident in a restricted environment. All actions should be thoroughly documented, the researchers stress.

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.